Hi Blog. We’ve dealt with cases of hospitals refusing to treat NJ patients before (see some cases here). Here’s something that’s never come up on Debito.org before: How even when NJ receive treatment, medicines may be ineffectual due to low dosages. Check this out. I’m not a doctor (well, not one that can write prescriptions), so I hope members of the medical community can weigh in on this one. Dr. Debito Arudou

I don’t tend to get sick often but just my luck, I was hit with some evil form of strep throat just as Golden Week started. After hours of hunting down an open hospital, and then another hour or so to hunt down an open pharmacist, I had my prescription antibiotic cut down to 2/3rds the prescription at the pharmacy. Apparently the doctor had taken my size into consideration when writing the prescription…but the pharmacists called him out on it exceeding the maximum daily dosage. I protested but was ultimately left with what the rest of the world considers a children’s dosage. After speaking with the pharmacist, doctor, and other pharmacists, what I found was the maximum dosage of certain medications is regulated by law and the maximum dosages for sales within Japan are determined by trials done exclusively on ethnic Japanese. I’m hardly a huge guy but at 75kg, I’m surely larger than the average Japanese. so this results in less than ideal dosages for nearly everything. For example, this time I was given:

acetaminophen:

Extra Strength Tylenol is 1000mg every 6 hours. Normal Tylenol is 650mg every 6 hours. Childrens Tylenol is 500mg every 6 hours. Japanese Calonol is 400mg every 6 hours.

clarithromycin:

Overseas recommended dosage is 250-500mg twice a day. Japanese dosage is 200mg twice a day.

Huscode 741 combo pills

Overseas adult dosage is 3 pills, 3 times a day. Overseas children’s dosage is 2 pills 3 times a day. Japan dosage is 2 pills, 3 times a day.

Basically, strict regulation of dosage size, based on the average ethnic Japanese rather than a more reasonable system based on body weight or age like in other countries. The end result is ineffective, children’s dosing or less for those of us who don’t fit the garigari average Japanese body size standard.

Probably not intentional racism but the narrow-minded mindset to use only locals for domestic Japanese consumptions means at the end of the day, it is likely to affect most NJ patients as well as any Japanese that are larger than the average Japanese. Every doc and pharmacist agreed the dosages were too small but gave the usual shogainai/gamanshikadekinai answers.

Sincerely yours, StrepThroat

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If I was him I would have just taken double the dosages (since he was given the pills anyways) myself. Then gone to another doctor and just gotten another prescription. It’s a pain in the ass especially when some hospitals aren’t open during Golden Week, but when it’s the law to only give out that much dosage not much you can do.

I’m 157 kilos, I know you the pain of small dosages but the doctors always said just take the meds and if I need more to just come back when they run out. I’ve run out earlier before and they just gave me a brand new batch lol

Happened to me multiple times, ask most Japanese and they will tell you foreign medicine is “too strong for Japanese.” TkyoSam has the right idea, two different hospitals, two different pharmacies. find the correct dosage online and error on the side of caution.

Having participated in medical trials myself, I can tell you they do indeed separate participants based on race.

A friend of mine was in hospital in Tokyo for surgery. She happened to have a rather high tolerance for all kinds of medications, and she also was very tall and weighed around 70kg. She ended up having a really hard time recovering because she was always in pain, and the doctor refused to raise her dosage of painkiller. She told me that the doctor said that he thought she was some kind of drug addict because she kept asking for more pain meds.

That was my number one fear when I went into hospital this month for surgery, but either I have a high tolerance for pain or I have a low tolerance for painkiller, because I didn’t have any problems. I only had to ask for more painkiller twice, and both times it was given to me without question.

In fact, the nurses kept asking me if I needed more, and looked dubious when I said I was okay. LOL. I think I was lucky in that my surgery was simple and there were no complications.

I’ll second Tkyosam’s comment. If this reader knows the dosages, let him dose himself. Acetaminophen is 4 to 6 hours, not strictly 6 hours. Antibiotics are not a “more is always better” type of thing, probably best to keep it to a minimum.

What I want to know is why this reader is invoking the phrase “ethnic Japanese.” The tests are only conducted on Asians? That I can buy. But are patients’ ethnicities screened before participating? I have a hard time imagining that. Not to mention the ethnic majority in Japan are Wajin. There is no such thing as “ethnically Japanese.”

I simply meant the local Japanese when I said “ethnic Japanese.” I only made a point of race as my naturalized Caucasian friend was thrown into the gaijin test group despite them knowing he’s holding a Japanese passport.

I can understand the hesitancy to overdose and such but when we’re talking children’s dosages or less, that’s beyond reason. Then consider them being used on adults larger than they have tested the small dosage for. The drugs are not effective and in the case of antibiotics, you run the risk of creating antibiotic-resistant strains of all kinds of bad stuff….which Japan is becoming quite famous for over the past years. Super Gonorrhea anyone?

It’s probably not just the under-dosing but the fact that they tend to prescribe the low doses for only a 3 or 5 days at a time and ask patients to come back for more. Inevitably, many won’t return and their doses get cut short. Always feels like a scam to get you back in for another visit since there seems to be no rhyme or reason to it and you can often push to get at least a full weeks worth.

“There is no such thing as “ethnically Japanese.” – What? I always thought that Japanese are an ethnicity or a race. Definition of ethnicity: the fact or state of belonging to a social group that has a common national or cultural tradition.

Yeah, always have this problem with pain killers in Japan; doctor always writes prescription, says that I’m a big guy and that I might need double the dose, then I tell him that I might need double the amount of meds, then he has to write a new prescription.
My concern is the anti-biotics dosages, never seems enough, and infection persists, forcing me back to the doctor. But surely this is just a racket where the doctors and pharmacists exploit patients in order to effectively gouge as much as they can from the government via the patients health insurance? The government knows but turns a blind eye since medical associations etc, advise members to vote LDP (except that year when the DPJ won), so this is effectively another form of corporate welfare/vote buying/pork barreling/corruption at the highest levels of society. Y’know, just Japan’s ‘unique culture’.

In regards to antibiotic performance at these lower dosages, it’s been a full week and the fever is just subsiding now. Throat still feels terrible. Tons of variables and assuming this was correctly diagnosed but basically the meds haven’t shorted the duration at all. I would have been better off getting rest and popping the Tylenol I already had rather than spending hours hunting down an open hospital and pharmacy during golden week.

Well, yeah, no doubt you’re feeling as though your GW would have been better spent on the sofa, rather than wasting your time trying to get medical treatment. I feel for you, but this is not so surprising I think; typical Japanese inflexibility when confronted by a foreigner/little Hitler syndrome/Japan’s ‘laws & rules’ gray zones incompletely understood leading to professional confusion. Very Japan I think.

The doctors churn their patients, making them come back for unnecessary visits, for example, to get new prescriptions filled. The medication, like pain killers, are almost useless for me. As are cold medications in Japan.

Is this definitively a matter of size, or of ethnicity/race? I’ve heard of the generally lower dosages in Japan, and always assumed it was more about cultural differences in willingness /hesitancy to take (or prescribe) high dosages. That Japanese attitudes are just in a different place on the spectrum as to how much risk or damage from side effects is too much…

When prescribing medicine amounts, the patient’s weight must of course be taken into account.

So a pharmacy worker claiming, the “the law forces us to IGNORE the doctor’s weight-based-calculation, the law forces us to give all adults (even a 120kg adult) the same tiny amount of medicine as we give the “standard Japanese citizen” (60kg)” is a total lack of logic and lack of care for taller/bigger/more-muscled minority humans living in Japan.

The poster StrepThroat’s doctor properly took the weight into consideration, and wrote a prescription for 1/3 extra medicine: the pharmacy REFUSED to give that amount. The pharmacy claimed “The Doctor wrote an illegal prescription, Japanese law states that all adults can only receive the exact same amount in Japan, regardless of weight.” Either such a law exists, or the pharmacy was simply lying and the doctor decided to meekly go along with the pharmacy’s [false] claim about “Japan’s laws.”

Meanwhile, Jim’s doctor (when pushed) properly took the weight into consideration, and wrote a prescription for double the medicine: which Jim’s pharmacy ALLOWED, thus disproving StrepThroat’s pharmacy Nazi’s claim that that is “impossible and illegal.”

And yeah, in addition to this problem here (of lying about laws being allowed, and illogical actions being allowed), there is overlaid upon that the other problem of refusing to complain about Japanese government actions which damage all people living in Japan, in which the majority feels that instead of complaining, they should just A) pretend the problem doesn’t exist, or B) pretend the problem is “some great positive quality of Japanese culture that we should continue, without improvement, forever!”

I almost ALWAYS take double the dosage of medicine. If the doctor doesn’t even know my weight, I have know for a fact the prescription isn’t accurate, so I have to look up the details myself. It’s a huge, HUGE problem.

I believe Dr. Kurosu(?) wrote and article years back about this and the threat it has for psychological treatment and medicine dosages.

Question is, can a pharmacist refuse/ignore the written prescription given by a doctor because they don’t like it or agree with it, i.e who has the precedence?

Ive solved this issue years ago. I travel alot with my work, so when in SE Asia, i stock up on meds that are very easily available over the counter, which in most developed countries are prescription only. Ok..it is self medicating, but, once i get any prescription from the Doc, i check to see which ones i have for a ‘normal’ dosage and use the ones i have.

Or, you can buy many meds on line now. The kicker is, make sure you dont order more than 30 tablets of something. I had an order of 60 tablets of anti inflammatories (to stock up) blocked. But after discussing with the customs office, a personal allowance of up to 30 tablets is allowed without any questions or being refused. So i had to let them keep/destroy 30 of my tablets otherwise they woudl just return the whole lot to the source.

So i have a nice little pharmacy at home…just use it when necessary.

I wouldn’t advocate using antibiotics at all…unless seriously life threatening ill too.

i had the exact opposite problem a quack doctor here over prescribed me medicine over here for a hernia in my neck and I had very severe side effects. so its better to be under prescribed then over prescribed . The quacks reason for the big dosage was because im a big guy so I can handle it, wrong! I almost died.

I got lucky I guess. During a yearly visit, returning from a side visit to Bali I came down with a fierce case of bronchitis that turned into pnumonia. Finally it got hard to breathe over a long weekend.

I ended up with my friend’s help at a clinic near a military base in Kanagawa. Waiting room full of kids with colds and after 50 minute wait, some pantomime and translation by my friend, I walked out with a 10 day supply of Cipro, standard adult dose plus an expectorant.

The clinic dispensed right there. Total cost appx Y8500.

I’ve had cipro before; the good stuff. Started feeling better that evening. Checked online, got the regular dose. Perhaps the doc was spooked by my return from Bali? Perhaps having the dispensary right on-site along with the physicians prevented any second-guessing. Perhaps the proximity to the base?

i know a Japanese pharmacist personally and the guidelines are based on average bodyweight statistics that are many decades out of date. many doctors agree this needs to be fixed, but it can’t, because making changes would require retraining and there is just no time for that.
consultation prices haven’t been allowed to rise for many years, and so doctors cannot maintain their practices (let alone profit) unless they see the maximum possible number of patients every day – this is why consultation time is only 3 minutes in japan. medical licenses are for life, and so doctors are never required to retrain, and though they can do so optionally, they take a large financial loss for the time spent closed, and also the retraining is ineffectual because any new practices cannot be performed because there is no infrastructure, since every other doctor is also spending every day as their practice.
the last time I went back to Australia my doctor wouldn’t believe that i’d had a certain test done in japan because it was phased out in the 90’s.